Elder Abuse: A Crying Shame
Monday April 3, 2000
Print This- Select Text Size:
Comments
Children are not the only age group subject to abuse. Elder abuse is shrouded by family and personal secrecy.
advertisement
Although every state has laws to protect the elderly, incidents of maltreatment are underreported because abuse and neglect are hidden under the shroud of family and personal secrecy. Terry Fulmer, RN, PhD, FAAN, professor and director of The Muriel and Virginia Pless Center for Nursing Research, says, "It is important to remember that cognitively impaired individuals cannot give an accurate history." Fulmer, who is also codirector of the Hartford Geriatric Nursing Institute at New York University School of Education, Division of Nursing, Manhattan, refers to the difficulties some healthcare providers experience in reporting elder abuse due to their unfamiliarity with laws, fear of offending patients, time limitations, and the lack of appropriate evaluation skills.
What Is Elder Abuse?
Elder abuse is any deliberate action or negligence that harms elderly individuals. Maltreatment of an elderly person can be physical, sexual, psychological, emotional, or financial. Abuse can be categorized as domestic, institutional, and/or self-neglect. Most states recognize five types of domestic elder abuse -
· Physical: nonaccidental use of physical force that results in bodily injury, pain, or impairment
· Sexual: nonconsensual sexual contact of any kind with an elderly person
· Emotional or psychological: willful infliction of mental or emotional anguish by threat, humiliation, intimidation, or other insulting conduct
· Neglect: failure by the caregiver to give an elder food, drink, necessary hygiene, or physical aids; psychological neglect can mean leaving a person for long periods of time or failing to provide social contact.
· Financial exploitation: unauthorized use of funds, property, or resources; this may involve stealing possessions or coercing legal transactions.
Institutional abuse refers to maltreatment of an older person living in a nursing home or other residential facility. The January 28, 2000, CBS report, Eye on America, vividly portrayed the dangers of nursing home care. "Neglect is a silent killer of the elderly; the threat is not what is done to patients, but instead, what is not done for them." The report also stated, "By some estimates, malnutrition, dehydration, bedsores, and infection - caused by neglect - account for half of nursing home deaths and injuries."
Self-abuse refers to neglecting one's health in a way that could adversely affect comfort or safety; this often results from a person's physical or mental impairment. American Medical Association guidelines describe how elders' human rights could be violated as well: "Some of these issues include a total lack of privacy, not allowing elders to make decisions about their healthcare, ignoring their rights to personal choices, and forcing some of them into nursing homes against their will."
Fulmer strongly agrees with the theory that seniors have a right to self-determination. "They should be encouraged to make decisions regarding their own welfare," she says. According to the Admin-
istration on Aging, "If an elder is mentally competent and chooses to stay in an abusive environment, that decision must be respected." Follow-up visits help monitor the situation to reduce risk to the victim.
Who Are the Victims?
The National Center on Elder Abuse suggests that certain groups of elders are more vulnerable to abuse than others. Elders who have mental or physical disabilities are at the greatest risk. Victims of physical and psychological abuse are most likely to be married or living with a child. Elders in poor health are usually socially isolated, increasing their vulnerability for all types of abuse.
Fulmer stresses the role of nurses in identifying the abused elderly: "Nurses must take the lead in recognizing, reporting, and seeking help for the frail elderly. With a good reporting system in place, nurses can follow a clearly delineated safety plan to get immediate help from social services, an elder abuse team, or administration while the patient is still in the hospital or agency."
Nurses must also help patients avoid feelings of embarrassment, shame, and helplessness. "Interventions can be simply asking some basic questions," adds Fulmer, such as "Do you feel safe in your home?" "Is there something you'd like to talk about?" "Do you have a plan if something like this happens again?" In addition, all nurses should be aware of adult protective services available in their communities.
Who are the Abusers?
No characteristics can reliably identify abusers. However, family members with mental, emotional, or substance abuse problems may be more likely to abuse an elder. The stress of caring for an elderly person can sometimes lead to neglect or abuse, especially if caregivers are emotionally or financially dependent on the victim.
Ann Corre, RN, training associate, Brookdale Center on Aging of Hunter College, NY, says, "A history of domestic violence can result in the abuse of elderly family members. In some cases, adults who were mistreated as children abuse their aging parents." Sometimes, elder abuse is a continuation of an ongoing pattern of spouse abuse. Spouses who batter do not necessarily stop just because they turn 60 years of age.
Hiding Behind Fear
Nurses investigating possible cases of maltreatment must often overcome substantial barriers. Unfortunately, victims of elder abuse are frequently reluctant to report offenders and are not willing to pursue a criminal investigation. They may fear being abandoned by the abuser or have feelings of embarrassment and shame.
Victims may not recognize the abuse or not know how to get help. Elderly people are often resistant to intervention because they fear that losing a caregiver will mean they'll have to be put in an institution.
One risk factor for elder maltreatment is caregiver stress. Corre notes that caregivers become weary. "Sometimes the caregiver doesn't know how to care for a dependent elderly person and may feel that there is nowhere to turn for support," she says.
Stopping the Cycle
Elder abuse is one of the most underreported social problems in this country today. Corre stresses, "Nurses should recognize the telltale effects of abuse and that isolated seniors are most vulnerable to maltreatment by caregivers." Several patterns or types of injuries detected on x-rays or CT scans should raise suspicions of domestic violence.
As this unspeakable reality reaches epidemic proportions, nurses must be taught to recognize the manifestations of elder abuse. "The elderly are frail and can die from physical abuse," says Fulmer. "New York State mandates reporting of child abuse. Why can't this be expanded to all types of abusive situations?"
"Nurses must respond as conscientious caregivers, responsible individuals, and honest members of society," Corre adds. Patient denial, fear of retaliation, cognitive impairment, or financial constraints should not keep healthcare providers from protecting our community's oldest members. Elder abuse is a crumbling cornerstone of what we consider a highly civilized society.
Reader Comments
Login